MEDICARE: EXTENDED FAMILY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	016588	TX

General Provider Information

NPI Number	:	1730564303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED FAMILY INC

Provider Business Mailing Address
First Line	:	10333 HARWIN DR STE 152
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1542
Country	:	US
Telephone Number	:	832-538-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 HARWIN DR STE 152
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1542
Country	:	US
Telephone Number	:	832-538-1467
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DEBRICA MARIE ROBERT
Credential	:
Telephone Number	:	337-507-3819

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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Directions to “EXTENDED FAMILY INC ” Practice Location

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